Objective To explore the cause and effective management and prevention of septic shock after minimally invasive percutaneous nephrolithotomy (MPCNL) in the elderly.Methods Clinical data of 13 patients with septic shock after MPCNL in our hospital were retrospectively analyzed,and the cause,prevention and treatment of septic shock were investigated.Results The incidence of septic shock in patients undergoing MPCNL was 3.54％ in this study.Single-factor analysis and logistic regression analysis showed that the risk factors for post-MPCNL septic shock were female and the history of diabetes (both P＜0.05).Conclusions Septic shock is a serious complication after MPCNL.Intensive perioperative prevention measures can reduce the incidence of septic shock.Early diagnosis and proper treatment are the keys to successful treatment of septic shock.

Objective To evaluate the value of Compas technique( computed optimun method for profile angle of singht,Compas) in displaying intracranial aneurysms. Methods DSA images of 31 cases of subarachnoid hemorrhage diagnosed by CT were studied. The DSA images in routine A-P and Lateral projections were compared with the images obtained by Compas technique in the same equipment. Results 23 of 31 were diagnosed as intracranial aneurysms by Compas and confirmed by operation, while only 5 were diagnosed definitely with routine A-P & Lateral projections. The other 18 studies were discovered as blurred margin of the artery but indefinite for the diagnosis of aneurysms. There is a statistical difference between the two methods. ?~2=14.93,P

Objective To compare the rates of successful intubation between light-stylet and adjustable McCoy laryngoscope for the management of difficult airway with active oral bleeding. Method Thirty casualties traumatized with active oral bleeding were enrolled after failure of endotracheal intubation tried twice by an attending doctor with Macintosh laryngoscope. The patients were randomly( random number) divided into light-stylet (LS)group and McCoy laryngoscope(MC) group ( n = 15 in each group). The rate of successful intubation and the time consumed for intubation were recorded. Results The rate of successful intubation at the first attempt and the total rate of successful intubation in LS group were higher than those in MC group (14/15 vs. 6/15, P =0.005, 15/15 vs. 9/15, P =0.017, respectively). The time consumed for intubation was less in LS group than that in MC group (24 seconds in average,ranged from 23 ～ 34 seconds vs 48 seconds in average, ranged from 31 ～ 119 seconds, P =0.011). Conclusions The light-stylet is a novel tool for intubation in casualties with difficult airway and active oral bleeding with high success rate.

Objective To investigate the state of chronic low-grade inflammation in healthy elderly adults and its related factors.Methods A total of 762 healthy people aged 30-99 years were retrospectively analyzed and assigned into 2 groups:the young group(30-59 years old,n=272)and the elderly group(60-99 years old,n=490).Patients in the elder group were subgrouped into 2 groups:the 60 to 79-year-old group(n=288)and the 80 to 99-year-old group(n=202).The differences in levels of tumor necrosis factor(TNFa) and hypersensitive C-reactive protein (hsCRP) were compared between groups.Correlations of TNFα or hsCRP levels with age,body mass index(BMI)and metabolic indexes were analyzed.Results The levels of TNFα and hsCRP were higher in elderly male group than in the young male group[(16.03±2.32) ×1015 mol/L vs.(15.28±2.63) × 10-15 mol/L,(1.30±1.01mg/L) vs.(0.79±0.61) mg/L,P=0.019 and 0.048],while there was no obvious difference between the 60 to 79-year-old male group and the 80 to 99-year-old male group(P =0.957 and 0.937).TNFα and hsCRP levels were higher in the elderly female group than in the young female group[(15.76 ±2.66) × 10-15 mol/L vs.(14.43 ± 3.18) × 1015 mol/L,(1.30 ± 0.81) mg/L vs.(0.75 ± 0.74) mg/L,P =0.006 and 0.001],and no difference were observed between the 60 to 79-year-old female group and the 80 to 99-year-old female group(P=0.282 and 0.389).Spearman's rank correlation coefficient analysis showed that TNFα level was positively associated with age,total protein,albumin,totalcholesterol,glomerular filtration rate,uric acid (P ＜ 0.05) in man and positively associated with age,triacylglycerol and fasting blood glucose in woman,while hsCRP level was positively associated with age,body mass index,total-cholesterol and negatively associated with total bilirubin,direct bilirubin and indirect bilirubin(P ＜0.05)in man and was positively associated with age,alkaline phosphatase,triacylglycerol and fasting blood glucose and negatively associated with GFR(P ＜0.05)in woman.Conclusions Healthy elderly people are often in a state of chronic low-grade inflammation,which is closely related to several metabolic parameters.

Objective: To understand the consistency of ALK Ventana-D5F3 immunohistochemistry (IHC) interpretation in Chinese lung adenocarcinoma among histopathologists from different hospitals, and to recommend solution for the problems found during the interpretation of ALK IHC in real world, with the aim of the precise selection of patients who can benefit from ALK targeted therapy. Methods: This was a multicenter and retrospective study. A total of 109 lung adenocarcinoma cases with ALK Ventana-D5F3 IHC staining were collected from 31 lung cancer centers in RATICAL research group from January to June in 2018. All cases were scanned into digital imaging with Ventana iSCANcoreo Digital Slide Scanning System and scored by 31 histopathologists from different centers according to ALK binary (positive or negative) interpretation based on its manufacturer′s protocol. The cases with high inconsistency rate were further analyzed using FISH/RT-PCR/NGS. Results: There were 49 ALK positive cases and 60 ALK negative cases, confirmed by re-evaluation by the specialist panel. Two cases (No. 2302 and No.2701) scored as positive by local hospitals were rescored as negative, and were confirmed to be negative by RT-PCR/FISH/NGS. The false interpretation rate of these two cases was 58.1% (18/31) and 48.4% (15/31), respectively. Six out of 31 (19.4%) pathologists got 100% accuracy. The minimum consistency between every two pathologists was 75.8%.At least one pathologist gave negative judgement (false negative) or positive judgement (false positive) in the 49 positive or 60 negative cases, accounted for 26.5% (13/49), 41.7% (25/60), respectively, with at least one uncertainty interpretation accounted for 31.2% (34/109). Conclusion There are certain heterogeneities and misclassifications in the real world interpretation of ALK-D5F3 IHC test, which need to be guided by the oncoming expert consensus based on the real world data.